Preoperative Exposure to Low-Calorie Sweeteners and Bariatric Surgery Outcomes
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ORIGINAL CONTRIBUTIONS
Preoperative Exposure to Low-Calorie Sweeteners and Bariatric Surgery Outcomes Rena C. Moon 1
&
Gayle Brazzi-Smith 1 & Andre Teixeira 1 & Muhammad Jawad 1
Received: 2 June 2020 / Revised: 13 August 2020 / Accepted: 14 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Low-calorie (LCSs) may be negatively associated with weight and metabolic health. We hypothesized that LCS exposure may hinder the effectiveness of bariatric procedures. The aim of this study was to examine the association between preoperative LCS use and weight loss/comorbidity remission following sleeve gastrectomy and gastric bypass. Material and Methods We performed a retrospective chart review of 653 patients who underwent one of the two bariatric procedures and provided preoperative diet information. Patients who selected LCS as one of their most commonly consumed sweeteners and/or included “diet” drinks or sugar-free foods in their 24-h diet recall were categorized as “LCS users.” We used multiple logistic regression models to address the study objectives. Results Of 653 patients, 470 (72.0%) regularly consumed LCSs. LCS users were more likely to be older, have lower preoperative BMI, diabetic, using insulin, and have hyperlipidemia than non-LCS users. LCS consumption was not associated with the odds of achieving BMI < 35 kg/m2 nor the odds of achieving TBWL ≥ 20% in the adjusted models. While 39.6% of diabetic LCS users did not show remission, only 22.7% of diabetic non-LCS users did so at their last follow-up (p = 0.04). However, this association was attenuated when adjusted for insulin dependency. Conclusions There is no clear harm or benefit of preoperative consumption of LCS on weight loss or comorbidity remission after bariatric procedures. Further study is needed to more accurately assess the effect of LCSs on bariatric surgery outcomes. Keywords Bariatric . Low calorie sweetener . Non-nutritive sweetener . Diabetes . Obesity . Weight loss
Introduction Low-calorie sweeteners (LCSs) refer to low- or no-calorie sweeteners including aspartame, acesulfame-potassium, saccharin, sucralose, and steviol glycosides (e.g., stevia) [1]. These sweeteners gained popularity as the public became more aware of the detrimental health effect of added sugar intake; LCSs were also increasingly consumed inadvertently via packaged foods and beverages [2, 3]. Between 2009 and 2012, 41% of US adults were consuming foods or beverages containing LCSs [4]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04931-4) contains supplementary material, which is available to authorized users. * Rena C. Moon [email protected] 1
Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, Orlando, FL 32806, USA
The effect of LCS on weight and metabolism is still inconclusive, and many randomized controlled trials claimed that LSC consumption was beneficial in weight management programs [2, 5–7]. H
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